Hierarchy levels

Hierarchy often is not too obvious. However, don’t be fooled by the use of the informal ‘Du’-address you might be offered by a superior. 

The hierarchy in medical institutions varies slightly between clinics, practices and university hospitals, but general patterns remain. In university hospitals there often is a rather strong hierarchical structure. At the top there is the clinic director or chair (Klinikdirektor), followed by senior physicians (Oberärzte) who head specialised departments or research areas. Assistant doctors (Assistenzärzte) and research assistants (wissenschaftliche Mitarbeiter) form the lower levels.

Professors and lecturers are also involved in research and teaching, which makes the structures more complex.

In non-university clinics or practices there usually is a flat hierarchy. The head physician (Chefarzt) is at the top, followed by medical specialists (Fachärzte), assistant physicians (Assistenzärzte) and specialised medical staff such as nurses.

In smaller practices, this hierarchy can be even flatter, with the practice owner and possibly a few salaried doctors and medical assistants.

Workflows are structured in all medical facilities to ensure efficient patient care and compliance with medical standards. These structures also help to clearly define responsibilities and promote communication.

In many medical facilities the ‘Du’ is often used, even between different hierarchical levels. However, it is custom that the ‘Du’ must first be offered by the management level. As long as this offer has not been made, the formal ‘Sie’ remains. This practice helps to maintain respect and professional distance, even in an informal atmosphere.

In modern medicine, increasing emphasis is being placed on ensuring that there is no difference between the sexes. Equal opportunities and equal treatment are key issues and many organisations are implementing measures to promote diversity and prevent discrimination.

In principle, there is gender equality. However, reality looks different at times.

In every medical institution, there are specific structures and hierarchies that can vary depending on the type of institution. Despite an often flat hierarchy at the bottom and a stronger hierarchy at the top, it is important to understand and respect the formal and informal structures. Modern medical work environments are increasingly striving for equality and a culture that supports all employees regardless of gender.